Student response. An anonymous survey was made of the entire class of human anatomy and physiology students at the end of the first year after the adoption of the case analyses. Students were asked to indicate the extent of their agreement or disagreement with each statement. Responses were received from 66 of the 68 students who completed the two-semester course sequence. Greater than 65% of the class agreed or agreed somewhat that their work on the case studies I) made it easier to learn anatomy and physiology (74%) 2) helped to deepen or solidify their understanding of anatomy and physiology (70%) 3) made them appreciate the relevance of learning anatomy and physiology (65%), 4) made them curious to learn more advanced concepts of anatomy and physiology (67%), and 5) were a useful way of learning anatomy and physiology (7 1%). These percentages show that a substantial majority of students found case studies to be beneficial to their learning and appreciation of anatomy and physiology.
Considering the extra effort required by the students, it was not unexpected that the overwhelming majority found the case studies to be “challenging” (91%). However, we were surprised that only 4 1% disagreed or disagreed somewhat with the statement that solving the case studies was “fun.” We had expected that a large majority of the students would disagree, since the cases involved substantial out-of-class work without an explicit guarantee of success. Indeed, we were pleased that a notable percentage of students (27%) agreed somewhat with the statement that solving the case studies was fun. This shows that, although the cases made our students work hard (i.e., were challenging), most of our students did not find the work unpleasant. Student performance. By the objective measure of test scores, the addition of case study analyses was associated with an improvement in the student’s performance on in-class exams. See Table 1 for the exam scores for our two-semester course in anatomy and physiology before and after the incorporation of case study analysis. The mean increase in exam scores was 7 out of 100 (P = 0.002; t-test, unpaired comparison, n = 6 exams). There was no substantial change in content or level of difficulty of the course between these two years.
Some of the difference could be attributed to year-toyear variability (the mean test score for a prior year was 66). The changing demographics of our students could also play a part, since progressively fewer first-year enrolled in our course in recent years. We had also increased the class time from 2 to 3 h/wk to accommodate the case work. Nevertheless, it is likely that the introduction of case studies made a substantial contribution to the improvement in our class exam scores. This conclusion is supported by the survey results in which most of our students indicated that their work on the case studies made the subject material easier to learn and helped them solidify their understanding of anatomy and physiology. The benefits of the case study analysis as perceived by the students are shown by a measurable improvement in the student exam performance.